Vinegar Ingestion for Diabetes

Overseen By Carol Johnston, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Arizona State University

Must not be taking: Insulin

Disqualifiers: Non-typical diet, Acute illness, Smoking, others

Compensation: Varies

Number of Visits: 2

Duration: 9 days

12 Participants Needed

Trial Summary

What is the purpose of this trial?

When linking dietary interventions and blood glucose management, much of the existing research - particularly studies exploring the effects of vinegar - has relied on discrete readings from the conventional testing methods: blood samples or glucometers. These methods lack the capacity to provide insights into blood glucose dynamics 24/7. Recognizing this gap, the current study aims to utilize continuous glucose monitoring to examine the impact of daily vinegar ingestion on glucose variability in adults identified as glucose intolerant.

Will I have to stop taking my current medications?

The trial requires that your medication use has been consistent for the previous 3 months and will not be discontinued during the trial. If you plan to stop any medications, you may not be eligible to participate.

What data supports the effectiveness of the treatment Daily Vinegar Ingestion, Apple Cider Vinegar, Acetic Acid for diabetes?

Research shows that regular vinegar use can modestly improve blood sugar control in people with type 2 diabetes, as it helps lower hemoglobin A1c levels, which is a measure of long-term blood sugar levels. ^{1 2 3 4 5}

Is vinegar ingestion safe for people with diabetes?

Research suggests that vinegar ingestion is generally safe for people with diabetes, but it may cause some side effects like changes in bowel movements, burping, flatulence, and acid reflux. It might also affect liver function and urine acidity, so it's important to monitor these if consuming vinegar regularly. ^{3 4 6 7 8}

How does daily vinegar ingestion differ from other treatments for diabetes?

Daily vinegar ingestion, particularly apple cider vinegar, is unique because it uses acetic acid to help control blood sugar levels by potentially increasing insulin sensitivity and reducing post-meal blood sugar spikes. Unlike many diabetes medications, vinegar is a natural product and can also offer antioxidant benefits, which may help protect against liver and kidney damage. ^{3 4 6 7 9}

Eligibility Criteria

This trial is for adults who have trouble keeping their blood sugar levels stable, known as glucose intolerance. It's not clear what specific conditions exclude someone from participating, but typically these might include allergies to vinegar or serious health issues that could interfere with the study.

Inclusion Criteria

Sedentary or moderately active (defined as a score ≤ 24 on the Godin-Shepard Leisure Time Physical Activity Questionnaire)

I have high blood sugar or a history of diabetes.

Exclusion Criteria

I am currently experiencing an acute illness.

I am not willing to drink vinegar.

Currently adhering to a non-typical diet that would impact carbohydrate intake (including weight loss diets)

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants are randomly assigned to consume either red wine vinegar or a placebo for 4 days, then switch to the opposite treatment for another 4 days.

9 days

2 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

1-2 weeks

Treatment Details

Interventions

• Daily Vinegar Ingestion

Trial Overview The study is testing how daily intake of vinegar affects blood sugar control over a full day. Participants will either drink liquid vinegar or take a vinegar pill and use continuous glucose monitoring to track changes in their blood sugar levels.

Participant Groups

Group I: Liquid vinegar Experimental Treatment 1 Intervention

Liquid vinegar (6% acidity) consumed at a dosage of 2 tablespoons (diluted in water and consumed at mealtime) twice daily (4 tablespoons total per day).

Group II: Vinegar pill Placebo Group 1 Intervention

One pill consumed daily in the morning.

Who Is Running the Clinical Trial?

Arizona State University

Lead Sponsor

Trials

311

Recruited

109,000+

Findings from Research

In a study involving 10 patients with type 1 diabetes and diabetic gastroparesis, apple cider vinegar significantly reduced the gastric emptying rate, with median values of 27% without vinegar and 17% with vinegar (p < 0.05).

The findings suggest that while vinegar may have benefits in healthy individuals, its effect of further delaying gastric emptying in diabetes patients could negatively impact their glycemic control.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of apple cider vinegar on delayed gastric emptying in patients with type 1 diabetes mellitus: a pilot study. Hlebowicz, J., Darwiche, G., Björgell, O., et al.[2021]

Daily ingestion of acetic acid in the form of vinegar led to a modest reduction in hemoglobin A1c levels by 0.16% in diabetic patients, indicating improved glycemic control.

In contrast, the use of vinegar pills and dill pickles resulted in slight increases in hemoglobin A1c levels, suggesting that not all forms of acetic acid consumption are equally effective for managing blood sugar.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preliminary evidence that regular vinegar ingestion favorably influences hemoglobin A1c values in individuals with type 2 diabetes mellitus. Johnston, CS., White, AM., Kent, SM.[2022]

A systematic review of six studies involving 317 adults with type 2 diabetes showed that vinegar consumption significantly improved fasting blood glucose and hemoglobin A1c (HbA1c) levels, indicating better glycaemic control.

The analysis also revealed reductions in total cholesterol and low-density lipoprotein levels after vinegar consumption, suggesting additional cardiovascular benefits, although the variability in vinegar content and small sample sizes warrant caution in generalizing these results.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A systematic review and meta-analysis: Vinegar consumption on glycaemic control in adults with type 2 diabetes mellitus. Cheng, LJ., Jiang, Y., Wu, VX., et al.[2020]

In a 12-week study involving 27 participants with type 2 diabetes, vinegar (VIN) ingestion was found to be generally safe, but 50-56% of those consuming pickles or VIN reported treatment-emergent adverse events, compared to only 11% in the reference group.

Chronic ingestion of VIN significantly reduced urinary pH and showed a tendency to increase liver enzyme levels, suggesting that VIN may affect liver function and metabolic pathways beyond just glucose metabolism.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A preliminary evaluation of the safety and tolerance of medicinally ingested vinegar in individuals with type 2 diabetes. Johnston, CS., White, AM., Kent, SM.[2013]

In a randomized crossover study with 11 participants with type 2 diabetes, vinegar consumption before a meal significantly increased glucose uptake in muscle and reduced post-meal plasma glucose, insulin, and triglyceride levels.

The study suggests that vinegar may improve insulin action in skeletal muscle, contributing to better glucose metabolism without affecting fat breakdown, indicating its potential as a dietary intervention for managing blood sugar levels.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vinegar Consumption Increases Insulin-Stimulated Glucose Uptake by the Forearm Muscle in Humans with Type 2 Diabetes. Mitrou, P., Petsiou, E., Papakonstantinou, E., et al.[2019]

Vinegar, particularly its main component acetic acid, has been shown to improve glycemic control more effectively in normal glucose-tolerant individuals than in those with type 2 diabetes or impaired glucose tolerance, based on data from human intervention trials.

The mechanisms by which vinegar enhances glycemic control include activating specific receptors that increase GLP-1 secretion, enhancing AMPK activation for better fatty acid metabolism, reducing circulating free fatty acids to improve insulin sensitivity, and promoting satiety, which collectively contribute to better blood sugar management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vinegar as a functional ingredient to improve postprandial glycemic control-human intervention findings and molecular mechanisms. Lim, J., Henry, CJ., Haldar, S.[2022]

Apple cider vinegar (ACV) supplementation significantly improved antioxidant enzyme activities and reduced markers of liver and kidney toxicity in diabetic rats, indicating its potential protective effects against diabetes-related complications.

ACV also demonstrated antihyperglycemic effects by lowering blood glucose levels and enhancing the overall antioxidant defense system, suggesting it could be beneficial for managing diabetes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Antidiabetic and Antioxidant Effects of Apple Cider Vinegar on Normal and Streptozotocin-Induced Diabetic Rats. Hmad Halima, B., Sarra, K., Jemaa Houda, B., et al.[2019]

In a study involving 12 healthy young adults, liquid vinegar significantly reduced postmeal glucose levels by 31% compared to a control and commercial vinegar tablets, indicating its efficacy in managing postprandial glycemia.

Commercial vinegar tablets, when taken whole, were found to be less effective than liquid vinegar in lowering postmeal glucose excursions, suggesting that the form of vinegar consumed may impact its effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Commercial Vinegar Tablets Do Not Display the Same Physiological Benefits for Managing Postprandial Glucose Concentrations as Liquid Vinegar. Feise, NK., Johnston, CS.[2022]

In a study involving 5 subjects, vinegar ingestion before a carbohydrate meal resulted in a modestly greater rate of glucose rise compared to a placebo, indicating that vinegar does not reduce blood sugar levels by affecting carbohydrate absorption.

The study utilized an oral octreotide/insulin suppression test to suppress insulin secretion, allowing researchers to better understand the effects of vinegar on glucose absorption, although the exact mechanism of vinegar's antiglycemic effects remains unclear.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vinegar lacks antiglycemic action on enteral carbohydrate absorption in human subjects. Salbe, AD., Johnston, CS., Buyukbese, MA., et al.[2013]

References

1. England pubmed.ncbi.nlm.nih.gov

Effect of apple cider vinegar on delayed gastric emptying in patients with type 1 diabetes mellitus: a pilot study. [2021]

2. Ireland pubmed.ncbi.nlm.nih.gov

Preliminary evidence that regular vinegar ingestion favorably influences hemoglobin A1c values in individuals with type 2 diabetes mellitus. [2022]

3. England pubmed.ncbi.nlm.nih.gov

A systematic review and meta-analysis: Vinegar consumption on glycaemic control in adults with type 2 diabetes mellitus. [2020]

4. United States pubmed.ncbi.nlm.nih.gov

A preliminary evaluation of the safety and tolerance of medicinally ingested vinegar in individuals with type 2 diabetes. [2013]

5. England pubmed.ncbi.nlm.nih.gov

Vinegar Consumption Increases Insulin-Stimulated Glucose Uptake by the Forearm Muscle in Humans with Type 2 Diabetes. [2019]

6. Germany pubmed.ncbi.nlm.nih.gov

Vinegar as a functional ingredient to improve postprandial glycemic control-human intervention findings and molecular mechanisms. [2022]

7. Switzerland pubmed.ncbi.nlm.nih.gov

Antidiabetic and Antioxidant Effects of Apple Cider Vinegar on Normal and Streptozotocin-Induced Diabetic Rats. [2019]

8. United States pubmed.ncbi.nlm.nih.gov

Commercial Vinegar Tablets Do Not Display the Same Physiological Benefits for Managing Postprandial Glucose Concentrations as Liquid Vinegar. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Vinegar lacks antiglycemic action on enteral carbohydrate absorption in human subjects. [2013]